=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255634051
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NANCY CATHERINE LALEAU LMFT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/16/2010
-----------------------------------------------------
Last Update Date | 12/16/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 330 TRES PINOS ROAD SUITE B-2, #12
-----------------------------------------------------
City | HOLLISTER
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95024-1652
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 510-691-8688
-----------------------------------------------------
Fax | 520-691-8688
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1600
-----------------------------------------------------
City | HOLLISTER
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95024-1600
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 510-691-8688
-----------------------------------------------------
Fax | 510-691-8688
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | #23329
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | #0093861
-----------------------------------------------------
License Number State | NM
-----------------------------------------------------